Provider Demographics
NPI:1003868472
Name:AFFILIATES IN COUNSELING LLC
Entity Type:Organization
Organization Name:AFFILIATES IN COUNSELING LLC
Other - Org Name:THE CENTER FOR DIVORCE RECOVERY
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MORTON
Authorized Official - Middle Name:C
Authorized Official - Last Name:MIRMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-480-0300
Mailing Address - Street 1:910 SKOKIE BLVD
Mailing Address - Street 2:215
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4013
Mailing Address - Country:US
Mailing Address - Phone:847-480-0300
Mailing Address - Fax:847-291-0576
Practice Address - Street 1:633 SKOKIE BLVD
Practice Address - Street 2:260
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2858
Practice Address - Country:US
Practice Address - Phone:847-480-0300
Practice Address - Fax:847-291-0576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1620796OtherBCBS OF IL
ILIL4389Medicare PIN
ILIL2558Medicare PIN